While Deaths Dwindle, Startling HIV/AIDS Infection Rates Continue

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By Penny Gray

St. Luke's-Roosevelt's nationally renowned Center for Comprehensive Care (CCC) has just opened a new location on West 17th Street in Chelsea. This brand-new, state-of-the-art facility at 230 W. 17th St. joins the CCC's other outstanding locations in New York City focused on HIV management.

"We have a beautiful space designed with the patient experience in mind," said Dr. Victoria Sharp, director of CCC. "We are so excited to offer the community here a true medical 'home,' where they may access a multidisciplinary array of services that are coordinated, convenient and of the highest quality in a single location."

The West 17th Street clinic aims to offer one-stop shopping for its patients' health care needs. Primary and specialty medical care, including dermatology, gynecology and cardiology, dental services, behavioral health services, acupuncture, massage and other services can all be found under the same roof. This approach not only simplifies treatment for patients but creates more coordinated care between the different health care providers.

Best of all, the West 17th Street clinic is taking care of HIV-positive and HIV-negative people of all insurance types, be it subsidized APAP, Medicaid, or commercial insurance.

Much attention was paid to the architectural possibilities of health care, so much so that clinic adopted "Redesign," an architectural model that mirrors CCC's commitment to efficient and democratic care. A patient arrives at a reception area, not a waiting room, and moves to a room where all services, including physician visits, labs, blood work and immunization, take place.

"We're really running a social experiment here. We've put a lot of thought into how architecture can affect behavior," said Dr. Antonio Urbina, associate medical director of the West 17th Street clinic. "And sure enough, by treating all patients with equal respect and dignity, we've seen how behavior improves. Last week, I treated a homeless man in one room and a CEO in the room next door. Both of them were receiving the best possible care."

The advent of the HIV drug cocktail in 1995 has transformed not only the life expectancy of HIV-positive people but also their quality of life-what was once a fatal disease is now a manageable chronic illness. "Thanks to the drug cocktails available, the lifespan for HIV-positive people has been increased by an additional 46 years. I even have an 87-year-old patient who is doing well.

"But those 46 additional years are not inexpensive; the cost is close to $1.5 million," continued Urbina. "We have to find a way to keep those costs down. Preventive health care all under the same roof is a great way to do that. If we can keep people healthy, we can keep them out of the emergency room and the hospital, where so much of that cost is incurred."

While the mortality rates of HIV patients may be on the decline, there are still 56,000 new infections every year in the United States.

"We haven't done a great job with prevention. That's where the challenge is," confessed Urbina. "In all risk groups, rates of infection have dropped, except in one key group. We've seen a 40 percent increase in infection in young, gay African-American men, aged 13 to 29. We're seeing very young, newly infected people; I diagnosed a 16-year-old last week."

While African-American men are disproportionately affected, there is no evidence to suggest that the group sees any increased drug usage or more sexual partners than any other risk groups.

New HIV prevention strategies must be incorporated to encourage protected sex at all times, as current methods seem to be ineffective. "I guess young people aren't so afraid of HIV anymore. They've grown up in an era when a couple of friends weren't dying every year from it," Urbina said. "They have seen Magic Johnson on TV and they know he's still alive. But despite the advances, it's still a disease that causes inflammation, premature aging and all sorts of bodily decline. Prevention needs to be taken seriously."

The team at the West 17th Street clinic is dedicated to compassion-not just toward patients but toward one another. "We're exploring the possibility of building a community, and accountability to community, in both patients and health care providers. This is the future of health care."

Members of the medical team at the recently opened St. Luke's-Roosevelt's Center for Comprehensive Care on West 17th Street. Photo courtesy of CCC.

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